Anthony Graves was 26 in 1992 when he was arrested for murdering six people in Somerville, Texas, outside Houston. At his trial, the prosecution presented no physical evidence to tie him to the scenes of the crimes, but he was nevertheless convicted and sentenced to death.

It wasn’t until the key witness in the trial recanted his testimony, weeks before Graves was to be executed, that new light was cast on his case. A judge later ruled that the prosecutor had withheld evidence and threatened witnesses, and ordered that Graves be released.

Graves had already spent 18 years in prison, including a dozen in solitary confinment, by the time he regained his freedom in 2010.

Now 49, Graves said the psychological damage of long-term isolation can linger. “Solitary confinement is a system designed to break a man’s will to live,” he said. “You’re sitting there, in a little cage, day in and day out, year in and year out, waiting for the state to execute you or release you.” After leaving prison he would suddenly burst into tears for no particular reason and had difficulty sleeping, though his condition has since improved.

Still, there are things Graves saw and heard all those years that he can’t forget. “I witnessed men just literally, literally losing their minds,” he said.

More than 6,500 inmates in Texas live in solitary confinement, according to a report published last week by the ACLU of Texas and the Texas Civil Rights Project. The figure does not include inmates who are living in solitary on death row. On average, prisoners remain in solitary confinement in Texas for almost four years, with more than 100 prisoners remaining in solitary for more than 20 years, the report states.

The conditions in which these inmates live “impose such severe deprivations” that they leave prisoners “mentally damaged,” and they are more likely to commit crimes again once they are released, according to the ACLU report.

“We met with people who were profoundly mentally ill. So mentally ill we didn’t feel comfortable sharing their stories in this report,” said attorney Burke Butler, a researcher who helped produce the report.

The Texas Department of Criminal Justice holds 4.4 percent of its prison population in solitary confinement, the report states—about four times the national average. This is in part because of the sheer size of Texas’ prison population, Butler said, but also because the state automatically places in isolation prisoners believed to have gang ties.

Nearly half the people in solitary are said to be gang-affiliated. But they are often misclassified for reasons as simple as having old gang tattoos, Butler said. An array of subjective decisions by prison personnel can also land inmates in solitary, such as the 19-year-old Butler spoke to who said his confinement was punishment for throwing milk at a guard.

Texas prisoners in solitary typically live in a 60-square-foot cell made of concrete. They have a bed and a toilet, both of which often double as tables for meals, Butler said. Prisoners can’t put anything up on the walls, and if they’re lucky enough to have a window, it’s just narrow strip of glass. They are usually allowed one hour of recreation time at least a few days a week, but they are often denied this reprieve because of understaffing or unwilling prison guards, he said.

Graves said he saw inmates on death row slit their own throats. Those that were released went back to the outside world “with a lot of baggage,” including PTSD and hypersensitivity.

“The first three years I was out…I couldn’t even hold a conversation with people without crying,” he said.

Repercussions like these have fueled a belief that solitary confinement is dangerously overused. Some states have started to limit the practice. In Mississippi, solitary is now reserved for prisoners who have attempted escape, committed a serious infraction, or are high-level, active gang members. Just last month, the second-largest jail in the U.S., New York’s Rikers Island, banned solitary confinement for anyone under 21. Even Texas prison administrators, known for their “severe” solitary standards, have recently agreed to try to reduce the number of prisoners in isolation, said Butler.

“If Texas is able to make positive reform, I think it will mean positive reform will be possible in other states as well,” he said.

The American Psychological Association and American Bar Association say mentally ill prisoners shouldn’t be in solitary. Pre-existing mental health issues can be exacerbated by isolation, experts say, especially when mental health services are restricted. Even those who are relatively healthy going in often develop psychiatric symptoms including panic attacks, hallucinations, and physical outbursts, said Butler.

Mental illness in prisoners isn’t just a problem on the inside, though. Ninety-five percent of all U.S. prisoners will get out one day, according to the Bureau of Justice Statistics. In Texas, prisoners released straight from solitary are rearrested at a 25 percent higher rate than those from the general population, according to the ACLU report. One reason is that inmates who emerge from isolation have been deprived of “educational, rehabilitative, and religious programming” and have lost an ability to interact with other people, the report states.

Correctional officers have begun to speak out about solitary confinement as well, and although isolation is often used to curb violence, some say it has the opposite effect. In Texas, serious assaults on prison staff have increased 104 percent over the last seven years, according to 2014 testimony from Lance Lowry, president of a Texas Correctional Employees union.

“It is the equivalent of locking a kid in a closet. It’s not going to fix a lot of problems,” said Lowry, according to the ACLU report.

Once prisoners are in solitary, Butler explained, correctional officers have little control over them because there are no longer privileges that can be taken away.

“When someone’s in solitary, they have nothing to lose. Their lives are miserable,” he said.

Today, Anthony Graves has everything to live for. He’s turned his nearly two-decade horror story into a career of advocating for change in the criminal justice system. He’s a seasoned public speaker and writer, and he has created a foundation for prison reform. He said he’s “much better” than when he was released almost five years ago, but that most solitary confinement prisoners are not so lucky.

“Please don’t judge the situation by looking at me,” he said. “I’m the exception, not the rule.”

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